Change for the Ohio nurse practitioner treating worker’s compensation patients: a needs analysis

Background: Autonomous nurse practitioners (NPs) are an effective and useful member of the healthcare team, particularly when given a less restrictive scope of practice at the state level. In Ohio - a midwestern state in the United States - NPs treating worker's compensation (WC) patients are limited in treating the injured worker because of the bureaucratic paperwork WC requires of its providers. Collaboration was initiated with an organisation in Ohio seeking to improve the profession of Advanced Practice Nursing through legislative change. Project and objectives were discussed, as well as a collaboration to get the legislation changed in Ohio regarding the NP Medco-14 form practice issue. Methods: This Needs Analysis quantitative study was completed by conducting chart reviews of WC patients assessed by the NP evaluating any disparities between work restrictions recommended by the NP versus the physician. The proposed work restriction instructions given by the NP were reviewed, and the review included only initial injury evaluation patients. The charts were randomly selected from the past schedules of two occupational NPs in rural Ohio. The charts selected at random were based on meeting the study inclusion criteria (first visit patient or new injury patient) in a chosen 3-month block time frame: January-March. Results: Of the 70 random charts reviewed, 100% had no discrepancies between the NP work recommendations and that of the physician. Conclusions: Allowing NPs to sign Medco-14 forms - also known as a return-to-work authorisation form or signed work excuse explaining limited work duties due to injury - will increase patient access to care, which in turn results in better patient outcomes. This study can be used as the foundational needs analysis to propose a legislative change in Ohio to allow NPs to independently sign the Medco-14 for Ohio WC patients. The collaborating organisation is currently drafting a legislative change proposal to modify the current Ohio NP Medco-14 restriction.